Provider Demographics
NPI:1760209944
Name:COLLAROS, ERINI VICTORIA (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ERINI
Middle Name:VICTORIA
Last Name:COLLAROS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SCHILLING DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-2351
Mailing Address - Country:US
Mailing Address - Phone:219-781-2804
Mailing Address - Fax:
Practice Address - Street 1:14151 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-1096
Practice Address - Country:US
Practice Address - Phone:708-201-8075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.017896235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist